HIgh versus STAndard blood Pressure target in hypertensive high-risk patients undergoing elective major abdominal surgery: the HISTAP multicenter randomized clinical trial.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Cecconi Maurizio, Cortegiani Andrea, Noto Alberto, Sotgiu Giovanni, Antonelli Massimo, Anderloni Marco, Barbaresco Ilaria, Bizzarri Federico, Brunati Andrea, Cappellini Iacopo, Cammarota Gianmaria, Caporale Mariagiovanna, Collino Francesca, Cuschera Monica, Coloretti Irene, Donadello Katia, Foti Lorenzo, Frassanito Luciano, Fiume Diego, Girardis Massimo, L'Acqua Camilla, Lauro Gianluigi, Maggiore Salvatore Maurizio, Magnoni Sandra, Mirabella Lucia, Misseri Giovanni, Miori Sara, Matronola Guia Margherita, Pavan Gaia, Pellis Tommaso, Piccioni Federico, Puci Mariangela Valentina, Pugliese Sara, Romanò Bruno, Russo Andrea, Samuelli Nicolò, Torrano Vito, Viani Andrea, Jaber Samir, Azoulay Elie, Romagnoli Stefano, Messina Antonio, SIAARTI Study Group
Аннотация
METHODS: HISTAP was a multicenter, randomized trial conducted at 18 Italian centers between March 2023 and April 2025. The study included patients aged ≥ 60 years with chronic hypertension requiring home therapy, undergoing elective major abdominal surgery and having at least one additional high-risk criterion. The intraoperative MAP was targeted to ≥ 80 mmHg (Treatment group) or ≥ 65 mmHg (Control group). The primary outcome was a composite endpoint including postoperative mortality and at least one major organ dysfunction.
FINDINGS: Of 636 randomized patients, 6 were excluded since surgery was canceled after randomization, 630 completed the trial and were included in the intention-to-treat analysis (median age, 74 years [IQR, 69-79]). Mean intraoperative MAP was 77 ± 7 mmHg in the Control group and 88 ± 9 mmHg in the Treatment group. The primary composite outcome occurred in 48.9% of patients in the Control group versus 38.1% of patients in the Treatment group (relative risk, 0.78; 95% CI 0.65-0.93; P = 0.006). Acute kidney injury was significantly less frequent in the Treatment group (23.5 vs. 33.7%; P = 0.005).
INTERPRETATION: Among hypertensive patients receiving continuous hemodynamic monitoring and protocolized fluid therapy at increased postoperative risk undergoing major abdominal surgery, targeting an intraoperative MAP ≥ 80 mmHg, compared with ≥ 65 mmHg, reduced major organ dysfunction, primarily due to fewer mild-to-moderate acute kidney injuries.
TRIAL REGISTRATION: The HISTAP trial has been registered at ClinicalTrials.gov, NCT05637606 (Date of registration: 24 November 2022).